Medicaid Business Analyst

Medicaid Business Analyst

Job Description

The Technical Medicaid Business Analyst serves as a critical bridge between Medicaid business operations and technical delivery teams. This role is responsible for translating federal and state Medicaid requirements, health plan business needs, and operational workflows into detailed functional requirements that support system configuration, data integration, reporting, and compliance. The analyst partners closely with business stakeholders, IT teams, vendors, and external partners to ensure Medicaid systems and solutions meet contractual, regulatory, and operational expectations.

Key Responsibilities

Medicaid Business & Regulatory Analysis
Analyze federal and state Medicaid regulations, contract requirements, and policy guidance and translate them into clear business and functional requirements.
Support Medicaid program areas such as eligibility, enrollment, claims, encounters, care management, provider management, quality, and compliance.
Interpret CMS, state agency, and contractual changes and assess operational and system impacts.

Technical Requirements & Solution Design
Develop detailed functional and technical requirements, including use cases, process flows, data mappings, interface specifications, and system configuration needs.
Collaborate with IT, data, and vendor teams to design and validate technical solutions that align with Medicaid business needs.
Support system enhancements, defect resolution, and new implementations across core Medicaid platforms (e.g., claims, encounters, care management, data warehouse).

Data & Integration Support
Analyze data flows between Medicaid systems, vendors, and external entities (state agencies, CMS, providers).
Support reporting, analytics, and regulatory submissions (e.g., encounter data, quality measures, financial reporting).
Assist with data validation, reconciliation, and root-cause analysis for Medicaid data issues.

Stakeholder & Cross-Functional Collaboration
Serve as a liaison between Medicaid business teams, IT, finance, compliance, and external vendors.
Facilitate requirements workshops, design sessions, and stakeholder reviews.
Clearly communicate complex technical concepts to non-technical stakeholders and business priorities to technical teams.

Testing & Implementation Support
Support system testing activities, including test planning, test case development, and user acceptance testing (UAT).
Validate that solutions meet Medicaid business and regulatory requirements prior to deployment.
Support go-live activities and post-implementation issue resolution.

Documentation & Governance
Maintain clear, audit-ready documentation of requirements, decisions, and approvals.
Ensure alignment with Medicaid governance, SDLC, and change management processes.
Support audits, regulatory reviews, and compliance inquiries as needed.

REQUIREMENTS
Experience in business operations, with the ability to understand and address complex business challenges.
Strong verbal and written communication skills, with a demonstrated ability to explain complex topics to diverse audiences.
Proven ability to collaborate effectively with both business units and IT teams, acting as a bridge between technical and non-technical stakeholders.
Experience translating business needs into clear, actionable inputs for technical partners.

5+ years of experience as a Business Analyst, with direct Medicaid or healthcare payer experience.
Strong understanding of Medicaid programs, managed care operations, and state/federal compliance requirements.
Experience translating business requirements into technical specifications.
Experience working with IT teams, system vendors, and data/reporting teams.
Strong analytical, documentation, and problem-solving skills.

Preferred Qualifications
Experience supporting Medicaid managed care organizations (MCOs) or state Medicaid programs.
Familiarity with Medicaid healthcare payer systems such as claims platforms, encounter processing, care management systems, or eligibility/enrollment platforms.
Experience with data analysis, SQL, or data warehouse concepts.
Knowledge of CMS reporting, state encounter submissions, or quality programs.
Experience with Agile, SAFe, or traditional SDLC methodologies.

Core Competencies
Medicaid subject matter expertise
Technical and systems thinking
Requirements elicitation and documentation
Data analysis and validation
Stakeholder communication
Regulatory and compliance awareness
Attention to detail and audit readiness

Education
Bachelor’s degree in Business, Information Systems, Health Administration, Public Health, or a related field (or equivalent experience).

Notes:
WFH 100%
Mon through Friday 830 to 5

VIVA is an equal opportunity employer. All qualified applicants have an equal opportunity for placement, and all employees have an equal opportunity to develop on the job. This means that VIVA will not discriminate against any employee or qualified applicant on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.